Development and teaching of complex skills in invasive procedures

Abstract

Performance of surgical and interventional procedures is based on complex skills, which are constituted by a mix of cognitive and psychomotor skills, including decision making, reasoning, and problem-solving. In surgical and interventional training, the cognitive aspects are often neglected resulting in inconsistent and often inefficient transfer of training aims, that is, acquisition of high professional standards of procedural conduct along with the ability to confront new, unforeseen situations. This chapter describes a combination of cognitive task analysis (CTA) and four-component instructional design (4C/ID) as an approach to develop effective surgical and possibly interventional training that takes the cognitive aspects of performance into account. CTA captures accurate descriptions of knowledge, thought processes, and goal structure expert operators employ to effectively perform complex tasks. 4C/ID develops training programs on the basis of CTA results, consisting of four components: (1) learning tasks, (2) supportive information, (3) procedural information, and (4) part-task practice. The application of CTA and 4C/ID is illustrated by the example of conducting a nephrostomy guided by ultrasound.